[Increasing compliance with a surgical antibiotic prophylaxis protocol in the Urology Service.] / Incremento del cumplimiento de un protocolo de profilaxis antibiótica quirúrgica en el Servicio de Urología.

INTRODUCTION: Surgical site infectionis the most common nosocomial infection in Spain. Theuse of surgical antibiotic prophylaxis (SAP) in clinical practice is frequently inadequate, confirming the need to adopt prevention strategies for this kind of infections. In this sense, promoting actions to improve the SAP in order to reduce surgical site infections is an unavoidable commitment of every surgical department. OBJECTIVE: To evaluate the adequacy of the PAQ after PAQ system implementation based on the use of prophylaxis protocols in compliance with the quality indicator sestablished in the Urology Department. MATERIALS AND METHODS: Retrospective observational study of the SAP of the surgical procedures performed in the Urology Service of a Spanish tertiary-level hospital. An intervention based on the introduction of the prophylaxis protocols was performed. Each prophylaxis kit contains sufficient antibiotic doses to perform an adequate PAQ with a registration form where the administration of doses is recorded. A period of pre-intervention (2005-2010) and post-intervention (2012-2017) were established  and the differences in the values were determined in the following six quality indicators: indication of SAP (indicated and administered prophylaxis), antibiotic selection (according to established protocol), dose and route of administration (therapeutic dose and intravenous route), time of administration of the first dose (between15 min and 1 hour before the surgical incision), intraoperative dose (necessary if the surgery is prolonged more than twice the half-life of the antibiotic or there is significant bleeding) and duration (not to exceed 24 hours). RESULTS: Compliance with the selection of the antibiotic,the time of administration of the first dose, the duration of prophylaxis and the overall adequacy of the SAP increased after the introduction of prophylaxis protocols (p <0.001). CONCLUSIONS: The use of prophylaxis protocols promotes an adequate SAP as it facilitates the appropriate antibiotic selection (active substance, dose and route) and helps to prevent SAP from being unnecessarily prolonged.

INTRODUCCIÓN: La infección de localización quirúrgica es la infección nosocomial más frecuente en España. El uso de la profilaxis antibiótica quirúrgica (PAQ) en la práctica clínica se realiza frecuentemente de manera inadecuada, lo cual pone de manifiesto la necesidad de desarrollar estrategias de prevención de este tipo de infecciones. En este sentido,la promoción de acciones de mejora de la PAQ con el fin de disminuir las infecciones de localización quirúrgica es un compromiso ineludible de todo servicio quirúrgico. OBJETIVO: Nuestro objetivo es evaluar el incremento de la adecuación de la PAQ tras la implantación de un sistema basado en la utilización de los kits de profilaxis conforme al cumplimiento de los indicadores de calidad establecidos en el Servicio de Urología.MATERIALES Y MÉTODOS: Estudio retrospectivo observacional de la PAQ de los procedimientos quirúrgicos realizados en un Servicio de Urología de un hospital español de nivel terciario. Se llevó a cabo una intervención basada en la introducción de los kits de profilaxis, cada kit de profilaxis contiene las dosis de antibiótico necesarias y suficientes para la realización de una adecuada PAQ junto con un impreso donde se registra la administración de dichas dosis. Se estableció un período pre-intervención (2005-2010) y post-intervención (2012-2017) y se determinaron las diferencias encontradas en los valores los siguientes seis indicadores de calidad: indicación de la PAQ (profilaxis indicada y administrada), selección del antibiótico (según protocolo establecido), dosis y vía de administración (dosis terapéutica y vía intravenosa), momento de la administración de la primera dosis (entre 15 min. y 1 hora antes de la incisión quirúrgica), dosis intraoperatoria (necesaria sI la cirugía se prolonga más de dos veces la vida media del antibiótico o hay hemorragia importante) y duración (no exceder 24 horas). RESULTADOS: El cumplimiento de la selección del antibiótico,el momento de administración de la primera dosis, la duración de la profilaxis y la adecuación global de la PAQ se incrementaron de manera estadísticamente significativa tras la introducción de los kits de profilaxis (p<0,001).CONCLUSIONES: La utilización kits de profilaxis constituye una estrategia de mejora que promueve la realización de una adecuada PAQ porque facilita que el antibiótico seleccionado sea el correcto (principio activo,dosis y vía) y ayuda a evitar que la PAQ se prolongue innecesariamente.

Auditing and Improving Surgical Antibiotic Prophylaxis.

BACKGROUND: There is extensive evidence of the efficacy of anti-microbial drugs in preventing infections from surgical efforts. Our objective was to describe the results obtained in our annual surgical antibiotic prophylaxis (SAP) audit in the years 2013-2017. METHODS: This was a retrospective observational study of SAP in surgical procedures carried out between 2013 and 2017 in a tertiary-level hospital. We examined the results from the services of general surgery, vascular surgery, neurosurgery, the breast unit, otolaryngology, maxillofacial surgery, traumatology, urology, pediatric surgery, gynecology, and plastic surgery. RESULTS: Establishment of six process quality indicators and their evaluation in the annual audit were carried out by the pharmacy service for approximately 500 operations. The indicators that had a high percentage of compliance were indication for SAP, choice of anti-microbial agent, dose and route of administration, and administration of an intra-operative dose when this was appropriate. In contrast, time of administration of the first dose and duration of prophylaxis had a worse percentage of compliance. CONCLUSIONS: Compliance with the SAP protocols in our hospital is high. We consider that these better results are attributable to the establishment of quality indicators of SAP and to the annual audit that evaluates said indicators. Communication of the results obtained in the audit to the surgical services, which have as part of their objectives included in their management contracts compliance with said SAP protocols, encourages improvement. The use of prophylaxis kits is an improvement strategy that facilitates the correct choice of anti-microbial agent and prevents SAP from being prolonged inappropriately.

Coronary vascular disease event risk and metabolic syndrome prevalence in patients enrolled in an assertive treatment community program.

OBJECTIVE: To examine the risk of coronary vascular disease event (CVDE) and the prevalence metabolic syndrome (MS) and its cardiovascular risk factors (CVRF) in patients with severe mental illnesses enrolled in an assertive treatment community program (ATC) in Spain. METHOD: We carried out a cross-sectional descriptive study with all of the patients included in an ATC program in 2016 in a health area with 547,328 inhabitants in Galicia, Spain. We identified the CVRF in all the individuals, and calculated MS and 10-year CVDE. We also compared the prevalence of all traits in our cohort and the general population. RESULTS: The 10-year median of coronary vascular disease event (CVDE10) was 8.4%. The percentage of individuals with high CVDE10 (>5%) was 41.2% The CVDE10 median was higher in men than women (10.5% vs 5.1%, p<0.001). MS was detected in 50% of patients without differences between men and women (51.2% vs 48.2%). A prevalence of 68% was found for smoking, 55% for dyslipidemia, 47% for obesity, 29% for impaired glucose metabolism, and 38% for hypertension. Women showed a higher prevalence of obesity measured by elevated waist circumference (88.9% vs 55.6%, p=0.003). Men showed a higher prevalence of arterial hypertension (46.6% vs 22.2%, p=0.0001). CONCLUSIONS: The SMD Patients enrolled in ATC programs had a 1.5-times higher prevalence of MS and 8 times higher CVDE10 than those reported in the general population. Individual CVRF were also higher in the SMD patients. Prevention, early detection, and comprehensive treatment are important issues for patients with severe mental illnesses.

Study on adherence to treatment with imatinib in chronic myeloid leukaemia and its association with therapeutic response.

OBJECTIVE: To assess the level of adherence to treatment with imatinib in patients with chronic myeloid leukaemia and its association with therapeutic response. MATERIALS AND METHODS: Study conducted on October, 2013 - March, 2014, including patients diagnosed with Chronic Myeloid Leukaemia on treatment with imatinib in the hospital. Therapeutic adherence was assessed through the standard Morisky-Green Questionnaire and the medication dispensing record. Those patients who did not complete 6 months of treatment and/or did not complete the questionnaire were excluded. Therapeutic response was assessed following clinical guidelines. The descriptive analysis of variables and correlation was conducted through Pearsons's Chi-Square Test. RESULTS: The study included 31 patients. When assessing the level of association between response variables and therapeutic adherence: 1. The highest molecular response was reached by 68.4% of those patients with high adherence, and by 75% of those patients with intermediate adherence. 2. Complete molecular response was achieved by 57.9% of patients with high adherence, and by 58.3% of patients with intermediate adherence. No statistically significant differences were found in response variables between patients with high and intermediate therapeutic adherence. No association was observed between level of adherence and therapeutic response. CONCLUSIONS: We cannot confirm that a different level of therapeutic adherence might have an impact on response to imatinib, though this should be taken into account in cases of therapeutic failure or sub-optimal response.

Objetivo: El objetivo es evaluar el grado de adhesión terapéutica a imatinib en pacientes con leucemia mieloide crónica y su relación con la respuesta terapéutica. Material y métodos: Estudio realizado en octubre 2013-marzo 2014 que incluye a pacientes diagnosticados de leucemia mieloide crónica en tratamiento con imatinib en el hospital. Se evaluó la adhesión terapéutica mediante el cuestionario estandarizado Morisky-Green y el registro de dispensaciones de medicación. Se excluyeron aquellos que no completaron 6 meses de tratamiento y/o no realizaron el cuestionario. La respuesta terapéutica se evaluó siguiendo guías clínicas. Se realizó el análisis descriptivo de variables y correlación mediante test Chi-cuadrado de Pearson. Resultados: Se incluyeron 31 pacientes. Al evaluar el grado de asociación entre variables de respuesta y adhesión terapéutica: 1. La respuesta molecular mayor fue alcanzada por el 68,4% de los pacientes con alta adhesión y por el 75% de los pacientes con adhesión media. 2. La respuesta molecular completa fue alcanzada por el 57,9% de los pacientes con alta adhesión y por el 58,3% de los pacientes con adhesión media. No se observaron diferencias estadísticamente significativas en las variables de respuesta entre pacientes con adhesión terapéutica alta y media. No se observó asociación entre el grado de adhesión y la respuesta terapéutica. Conclusiones: No podemos afirmar que el distinto grado de adhesión terapéutica influya en la respuesta al imatinib, aunque debería considerarse en casos de fallo terapéutico o respuesta subóptima.

[Pharmacokinetic monitoring as a new tool to individualize anti-TNF therapy]. / La monitorización farmacocinética como nueva herramienta para individualizar la terapia anti-TNF.

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